Readers' comments

Here's a really good comment by Pearlstein in the Washington Post a couple days ago:

Time for the Blue Dogs to Show Their True Colors

By Steven Pearlstein
Friday, July 24, 2009

In a Congress polarized by partisanship and ideology, the balance of power
often falls these days to centrist Democrats who, in the House, go by the
name of Blue Dogs. Over the years, I've never been able to tell whether
the Blue Dogs were the mushy kind of centrists just trying to reconcile
the demands of liberal leaders with the demands of their more conservative
rural districts, or radical centrists who reject the tired,
interest-group-driven ideas of the left and right and seek fresh solutions
based on free markets, balanced budgets and social compassion.

With health-care reform, we're about to find out.

The challenge for the Blue Dogs is that they want an America where
everyone has insurance but are reluctant to force workers to buy it or
employers to help pay for it.

They understand that achieving universal coverage will require subsidies
for low-income workers and small businesses, but they insist that none of
those changes add to the federal deficit or raise anyone's taxes.

They want to introduce more competition into the private insurance market,
but not if it comes from a government-run insurance plan.

They complain constantly about the need to rein in runaway Medicare costs
while at the same time demanding higher Medicare reimbursement rates for
doctors and hospitals in rural areas.

You see what I mean about mushy centrism?

That said, we can now thank the Blue Dogs for pushing House leaders to be
more aggressive in making the kind of fundamental reforms in the way
health care is delivered and paid for, which experts say is the surest way
to reduce waste, improve health outcomes and put the brake on health
spending.

The mechanism they've chosen to achieve these reforms is a new commission
of outside experts that would recommend changes in Medicare policies and
reimbursement rates for doctors and hospitals -- recommendations that
would take effect unless rejected by the president or by Congress. The
logic here is that the only way to reform Medicare is to insulate it from
the political pressure of powerful special interests, and that Medicare,
because of its size, will pave the way for similar reforms in the private
insurance market.

The problem with using Medicare to serve as the leading edge of reform,
however, is that it relies on a patient population, the elderly, that is
least able and willing to embrace change. A better vehicle would be the
new government-run insurance option that has become a political must-have
for House leaders and President Obama. In return for dropping their
opposition to such a "public option," the Blue Dogs could have insisted
that it not be structured as a fee-for-service plan along the lines of
Medicare but rather offer services through a network of high-quality,
lower-cost hospitals and clinics that use teams of salaried doctors to
provide coordinated care, along the lines of the Mayo and Cleveland
clinics that Obama is always touting. In a competitive market, the success
of such a government-run plan would force other insurers to follow suit.

There's still time for the Blue Dogs to improve their health-care reform
plan in other ways.

If they really want to solve the doctor shortage in their home states, for
example, they could propose a small tax on all hospital services and use
the money to provide free education to all medical students -- in exchange
for a few years of service in underserved communities.

If Blue Dogs were really the courageous fiscal conservatives they claim to
be, they would insist on a more modest benefits package for the basic
insurance policy that everyone would be required to buy under the House
proposal.

And, to help pay for universal coverage, they would back some sort of tax
on gold-plated benefit packages that encourage patients to consume too
much health care or become indifferent to what things cost.

If Blue Dogs were eager to break the hold of special interests, they might
have found a creative way to resolve the long-standing feud between
doctors and plaintiff's lawyers over medical malpractice. Although doctors
and their Republican supporters overstate the impact of exorbitant damage
awards and malpractice premiums, plaintiffs' lawyers and their Democratic
puppets understate the degree to which malpractice suits leads doctors to
overtest, overprescribe and overtreat. A centrist solution would be to
shield doctors from lawsuits when they follow protocols established by
national medical boards. It might also set a reasonable cap on punitive
damages -- but only in states that establish tough, independent boards to
investigate and discipline doctors.

The problem with the Blue Dogs is that they tend to confuse centrism with
splitting the difference between the warring camps, or making policy by
choosing one from Column A and one from Column B. The more effective
centrists use their political leverage to create a Column C.

Solidarity Principle:
No reform is credible if everybody isn't screaming.

So far not only the AMA is behind the Obama Democratic health care plans, the insurance industry also seems neutral to supportive.

Nobody is seriously asking employees to "sacrifice" their employer based health care for something that might even be better. Nobody is asking seniors to put up with any changes to Medicare. How are they going to pay for increased coverage for uninsured and where are they going to find cost savings for the whole economy?

So far only the Americans with highest income are being threatened with a little surtax. After all what are these wealthy americans going to do? Protest voting Republican next time? Not much chance of that eroding Democratic support.

Not a very bold plan Mr. President.

The only way a health care reform can bring any kind of real benefits to the country and the economy as a whole would be a solution that leaves everybody hurting a little bit. Most important employers need to be freed from the burden of providing health care to their employees; employees need the freedom to choose the health care solution and labour mobility that best suits; and some kind of solidarity / public financed solution needs to be conceived so nobody falls through the net.

Such a complicated dance, in which all the interests give a little would bring the greatest benefits. However that's probably too much to ask of a democracy. Let the party in power create a "winner take all" solution to satisfy their own base. Why should they sacrifice when they don't have to? And why should the blockhead opposition comprimise to give the ruling party and their Pres any kind of success - even if that would give them some kind of say in shaping the outcome? What may be good for the party is probably not good for the country. Comprimise is unfortunately not an option.

It's just too important to get it wrong. We all know how hard it is to create a new programme in the US. However once it's their, a new constituency emerges making it impossible to remove or revise.

The Economist itself has published several articles summarizing studies which found that people are much more scared to give something up than of not getting something they don't already have, even in cases where the outcome is the same, on average.

I think that's what's really at the core of it. The devil we know is the devil we trust.

Cherny, Hippogriffs are also outnumbered by unicorns in the U.S, according to polls. If we can discuss incremental change in measured tones rather than conceiving, presenting and rejecting every reform as either a red down or a brown night, that might help.

This seems like par for the course. People hate "congress" but like their representative. Most folks agree that our schools are broken, but a surprising amount think their school is fine.

As long as the costs of our mismanagement (education, health, social security, you name it) is obscured by deferring the pain until some unspecified point in the future it will be hard to get people to take the risks necessary for change.

Or perhaps the Democrats have been reading the poll numbers wrong all along. I daresay that for a large segment of Americans, "healthcare reform" means reining in the runaway cost of Medicare and Medicaid and not further expansion of government entitlement. Liberals keep forgetting that they're very much outnumbered by conservatives in this country...

Another possible reason for apprehension: Americans instinctively know something is wrong with their current system, and agree with the social goal of covering everyone, but also instinctively flinch at the thought of central control in a continental nation. At least that's where I'm at.